Utility Of Removable Rigid Dressings In Decreasing Discharge Narcotic Use And Improving Ambulation Following Below Knee Amputation
Amrita Sarkar, B.S., Robin Fencel, PA-C, Eleanor Dunlap, DNP, ACNP-BC, Suzanna Fitzpatrick, DNP, ACNP-BC, FNP-BC, Khanjan H. Nagarsheth, MD, MBA, FACS.
University of Maryland School of Medicine, Baltimore, MD, USA.
Objectives: Lower extremity amputations are often associated with limited post-operative functionality and post-operative complications. Removable rigid dressings (RRDs) have been utilized for post-operative care following below knee amputation (BKA) and have been shown to improve limb maturation, decrease post-operative complications, reduce time to prosthesis casting, and limit conversions to above knee amputation (AKA). This study aims to evaluate if usage of RRD following BKA correlates with decreased prescription narcotics required at discharge and improved ambulatory status at follow-up.
Methods: Retrospective chart review was conducted to identify all patients who underwent BKA performed by the vascular surgery service at a large, tertiary, acute care hospital between July 2016 and July 2021. Information was gathered on 95 patients regarding age, sex, body mass index (BMI), conversion to AKA, narcotic prescriptions at discharge, and ambulatory status at follow-up.
Results: Between July 2016 and 2021, rate of conversion to AKA was significantly lower in patients who received a removable rigid dressing (9.3%), as opposed to those who did not (41.5%) (p = 0.0002). Narcotic prescriptions at discharge, compared following conversion to morphine equivalents, were also significantly lower in the rigid dressing group compared to patients who did not receive the dressing (50.5 vs 108.9 morphine eq/24h, p = 0.0019). Furthermore, use of rigid dressing significantly improved ambulatory status at follow-up to 75.9% in RRD patients compared to 29.3% in patients with conventional dressing (p < 0.0001).
This statistical significance persisted after all patients who were converted to AKA were removed from analysis (79.6% vs 39.3% ambulatory, p = 0.000363).
Conclusions: These findings support the utility of RRD following BKA to reduce conversion to AKA, reduce narcotic dosages required at discharge, and improve ambulatory status at follow-up. The positive impact on ambulatory status persists independently of reduction in conversion to AKA. Given these findings and previously established benefits of RRD in improving outcomes, RRD should be implemented as standard post-operative care following amputation.
|Total||No Rigid Dressing||Rigid Dressing||p-value|
|Converted to AKA||23.2%||41.5%||9.3%||0.0002|
|Discharge narcotics (morphine equivalents/24h)||74.02||108.94||50.52||0.0019|
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